Shippers Information

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Last Name: *
Email Address: *
Phone: *
Lab: *

Recipients Information

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First Name: *
Last Name: *
Recipients Fedex Account#: *
Organization Name: *
Shipping Date: *
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Email Address: *
Phone: *
Shipping Address: *
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Item(s) Information

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Shipping Conditions: *
Declaration Value: *

Additional Instructions or Comments:

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